The influence of influencers is overhyped. We all want to believe that there are these super-hero influencers that can make dramatic changes to organizations, countries, and societies. The idea has been spread in pop-culture in books like Malcolm Gladwell’s the Tipping Point. Recent developments in Network Science have shown that our understanding of influencers – the super-connected individuals in our organizations and society – is more or less wrong.

So what is the truth behind influencers? The science is still figuring it out, but here is what we have learned so far.

It’s all about Micro-Influencers

The super-connected influencer do not exist, instead there are micro-influencers – those that have slightly more influence than the rest of the population influencing those around them to spread their ideas and messages about certain topics. (I would consider my friend Andrew a micro-influencer, he got our whole group of friends drinking high-quality craft beer after he himself jumped into the cult of American craft beer drinking).

We use to think that the human social network was constructed like our airport network (also called scale-free networks), there are hubs in which most traffic can get to most places, thus have huge influence on the flow of information.

The truth is that there are no Chicago O’Hare, or London Heathrow individuals. Why? Because the human network does not work like the airport transportation network. The human capacity to manage relationships is finite. Unlike our major airports, we cannot just construct another terminal in ourselves to deal with more traffic. We have a limited number of relationships we can actively manage and the reach of our direct influence is limited by the relationships we manage.

The average number of friends people have on Facebook is around 200 – but there are some Facebook users who have 2000 friends (the max for an individual account), which is only 1 magnitude greater, not 10 or 20 times greater like we would expect if our human networks were more like airports: like the difference between Colorado Springs Airport traffic and Chicago O’Hare.

Ideas Become Viral Through Micro-Influencers

Things still go viral and our common sense would tell us that it is because some super-connected influencer made it go that way … but then we would be wrong. Common sense is so wrong when it comes to influencers (see Duncan’s new book for a full explanation of why). We cannot predict viralness from super-connectors. We can, however, narrow down on a group of people where the viral ideas are likely to come from. The best probability of making something go viral is to know who your micro-influencers are. And there are ways to find them, see my post on how to make leadership contagious.

Micro-influencers at best can cause diffusion of ideas and changes in their immediate network that may cascade for up to three levels (from you – to your mom – to your mom’s yoga teacher – to your mom’s yoga teacher’s kid). Which btw is the same degree of influence Christakis and Fowlers noted in their book connected.

Susceptibles are just as important as Influencers

The role of susceptibles – those who get influenced – is just as important as the role of the influencer. If there is no audience to your message, is the person delivering the message, or message influential?

The truth is, until recently we didn’t know a whole lot about who we influenced, we just focused on who was doing the influencing. A recent study in Science by NYU professor Sinan Aral looked at the role of susceptibles in product adoption and what they found was pretty interesting.

One of the most important findings from this study is that the most influential people are the least able to be influenced … that can become an issue if you are trying to use these people to roll out some message or idea in an organization.

What does this mean for organizational change initiatives?

Here are my thoughts …

Don’t be naive about the impact a super-connector can have on your change initiatives (they probably won’t have that much power)

Don’t ignore the “little guys” individuals who are popular inside their own peer group – these are your micro-influencers

Influencers are hard to influence – if your initiative is important – get them on board, or move them to the periphery

Don’t neglect your audience – are they susceptible to influence around your ideas – you better do some profiling and discovery of your audience before you jump in there trying to influence

It takes more than just a org network analysis to figure out what people are influenced in your organization – don’t neglect the power of messaging, and the strength of alignment from the top

BTW – worth watching if you want to learn more about the Science behind Measuring Influence

Every now and then you need to wake up and smell your real world strategy. Strategic reality is about events, and coping, and figuring things out. Real world strategy is a living thing. Overconfidence in strategic planning has led to financial crisis, botched and illegal wars, and missed opportunities in business, politics, sports, and life. It has led to quarter of a million missing school places in the UK and over half of Spain’s youth being without work. Failed businesses from Lehman brothers to Blockbusters to Borders all had strategic plans. They all had charts and spread-sheets.

Give me time to think. In 2009 a Toyota vehicle hurtled down a highway with no brakes and a stuck accelerator and crashed into another car killing four members of the same family. In September 2009, Toyota recalled of 3.8 million vehicles but blamed a removable floor mat instead of the real cause and ignored reports of similar fatal crashes dating back to 2007. Not until February 2010 was there a full recall of 8.5 million vehicles, new parts to fix accelerator and brake problems and a public apology from the president along with a ceremonial bow criticized for being too little, too late.

Toyota is a remarkable organization. Its famed Toyota Production System (TPS) – a careful combination of process and collaborative culture – led them to the top for quality and satisfaction. Toyota’s 100 year plan had weekly strategic meetings after high level of consensus was gained from the core of Japanese managers with life-time contracts. If real world strategic failure can harm them it can harm you.

The real world is global, not local. Toyota’s strategic process involved consensus in Japan not consensus worldwide. It favoured head office ahead of the rest of the world. Senior managers forgot the Japanese principle of gemba – going to the place to understand the problem – or perhaps thought only applied to engineering.

The real world is about little things not just big things. TPS does produce quality inside but found it hard to notice important events outside that seemed less important – less urgent – less deserving of senior management attention. They were busy too looking at the big picture at a distance to see the detail that could trip them up.

The real world is about events in real time Leaders who hide away like monarchs of old – as with the ex-CEO of RBS who threatened to fire people for putting cheap pink wafers in his meeting room – are confused by events because they minimise, attack and deny reality. Smart leaders know events matter more to real strategy than fantasy strategy.

The future is not just more of the past The future is not a simple extrapolation of the successful past. Growth will not always be growth. Quality will not always be quality. Particularly if circumstances change – which they will – and if assumptions are not complete – which they never are. Action takes place in the real world so strategy needs to take place in the real world. You need open door strategy, real time strategy, with real people doing real things. Smart leaders consider little things, local things, and react to real world events to successfully shape the future.

Management is leadership and leadership is management. Your success may depend on it.

Leaders who are detached from the messy process of managing fail. They need to recruit board members, executives, and managers who are doers, not just joiners.

The headlines scream about leadership failure after failure around the globe every day–at the world’s biggest companies, in government agencies, at venture-backed startups, and even in organizations such as the Vatican. So why does leadership fail?

It became fashionable some years ago to separate “leaders” from “managers”–you know, distinguishing those who “do the right things” from those who “do things right.”

In practice, leaders who are detached from the messy process of managing fail. They don’t know what’s going on in their organizations. Stanford University Professor Emeritus James G. March has said “Leadership involves plumbing as well as poetry.” And I couldn’t agree more having experienced this throughout my career. The devil is in the details. Great leaders fail without good management.

There are a host of definitions of what constitutes leadership and what is management, including the idea that leaders envision and inspire, while management creates systemic processes for planning and execution. I would argue that among other things, one of the key elements is having transparent and repeatable management processes from the boardroom to the project teams.

Why Boards and Management Fail

Consider the following recent examples:

• At JPMorgan Chase, Ina Drew, the senior banker who has taken the fall for massive trading losses, was reportedly already faltering in 2010, two years after navigating the banking behemoth through the worst of 2008’s financial storm.
• High-flying Chesapeake Energy CEO Aubrey McClendon borrowed as much as $1.1 billion over the last three years against his stake in thousands of company wells without anyone raising a hand before facing the ire of shareholders.
• The U.K. Culture Minister Jeremy Hunt said he became worried about “a massive failure of corporate governance” at News Corp. in July 2011 after the media giant’s News of the Worldhacked the voice mail of a teenage girl who was later found to have been murdered. It then became apparent that the still-ongoing debacle had been of “growing concern to News Corp.” for months, according to Hunt.

Without the board of directors, senior management, and line managers all working together to execute strategy and ensure strict adherence to ethical practices and operating standards at a detailed level, it’s too easy for aberrations to go unnoticed.

The key is focusing on operational governance. Companies like to have marquee names on their boards–VIPs like former governors, senators and university presidents–as directors. Unfortunately, such celebrities often lack expertise in the businesses they’re overseeing, or have no time (or sometimes even the inclination) to roll up their sleeves and really do the work. To be able to do the work, one must understand the complex sets of decisions that are required in today’s interconnected environment.

Dimensions of Management Decisions

What distinguishes today’s successful enterprise is knowledge–such as knowledge of the customer, the suppliers, and new business ideas that could emerge from anywhere. The challenge for leaders is managing such extended enterprises which requires breaking many of the management rules we grew up with. Rather than top-down hierarchical processes and approaches, they need to manage and govern cross-collaboratively. In order to do this, the organizational structure must be adapted to nourish true coordination inside and beyond the extended enterprise.

In my last book, The Power of Convergence, we defined four decision dimensions to lead these extended, ever-evolving, knowledge-based enterprises:

Process: Is someone responsible for each process from beginning to end as it crosses divisions and bridges to outside entities? Where are the strengths and weaknesses in the process? How does it mesh with others? How many bridges are there to the outside? Are they coordinated? Are these processes and bridges maximized for the benefit of the customer, or for internal benefit? By what metrics do you know?

Organization: Which people or groups make which decisions? Do they have enterprise-wide information if they need it? Do they have an enterprise-wide perspective? Are incentives in place to encourage this? Do the incentives actually discourage this? Do they have proper authority? Who is empowered to step outside of traditional roles and boundaries to make a stand for the customer? Or to make a stand for the supplier?

Information: What information do the various players need to perform the preceding actions? What should you know about suppliers and customers, and how can you get this information? At what level should it be collected? When collected, how is it processed? Does it go to people who can make decisions to change how the organization operates? What incentives discourage the “not invented here” syndrome?

The really critical information will appear on the outer periphery of the extended enterprise: with your customers’ customers; their markets and new technologies they may be considering. It will appear in the commodities markets and technological innovations that fuel your suppliers. It may appear in think tanks or universities or in someone’s garage. Is your radar picking up these signals?

Technology: Not only must the technology be managed as one with the business internally, it must be planned for, purchased, and managed with the outside world in mind, as well. Look to standards, to web-based applications, to open architectures, and to the new social networking technologies for the appropriate tools. Closed, proprietary technologies do not fit an organization seeking to be part of a larger community. Look also to component-based architectures and cloud computing for the agility needed to sense and respond. All is in flux today; you can’t be tied down.

Strategic Business Risks

Leaders must provide active oversight over how business risks impact the business, and ensure the effectiveness of the governance models in mitigating these risks. Strategic risk refers to the risks facing the firm due to poorly envisioned or executed business strategies. Some of these risks include the following:

• Business model risk: This refers to the robustness of the business model and how well it is being executed.
• Competitive risk: This refers to the ability to sustain itself against competitive action and retaliation.
• Integration risk: This refers to the risks of inadequate integration between business strategies, execution processes, and supporting technology infrastructures.
• Misalignment risk:This refers to inadequate alignment between spending and business priorities.
• Governance models risk:This refers to inadequate participation and involvement of executives on key decisions and lack of understanding of inter-dependencies.

Leaders need to recruit board members, executives, and managers who are “doers,” not just “joiners.” Management governance requires the accountability of everyone within the enterprise, along with partners, distributors, suppliers, and anyone who plays a role in carrying out a business plan.

Dilbert (by Scott Adams) on Management

Dilbert has long made fun of leadership and management failure. On a lighter note, I thought the animation below captures the sentiments of organizational disconnects quite well. Happy trails…

Kelly Merrick is the social media mentor at Hive Strategies. You can check out the Hive Strategies blog here.

When you decide to start a health care-related blog, there are a lot of elements to consider. You have to determine how much time you can devote to managing a blog, what your comment policy will be, and some strategies for how to gain followers.

But there is something else you should consider, something that I think is perhaps more important than all of the above items: What purpose you want your blog to serve.

I read a lot of health care blogs, and for the most part, all of the blogs have a specific type, which features the strength of the writer. So, as you are preparing to start your own blog, I want you to consider what you want your blog to accomplish.

Do you want to educate your readers by giving them information about topics such as immunizations and the latest health research? Or do you want to tug on their heartstrings by telling stories? Or do you want to weave your own personal life experiences into your blog? This is a crucial step to take because it will ultimately decide why your readers return for more.

Educational

An educational blog is one that is practical. It covers topics that are useful to the audience and helps them make decisions for themselves. An educational blog is great for many reasons, and is a good choice if you are the type of health care provider who keeps up on the latest medical research and has a strong desire to share practical applications with a larger audience.

A great example of an educational blog is one by Registered Nurse Linda Scherf. Scherf manages her hospital’s Birthing Center blog in McMinnville, Oregon, and covers topics from car seat safety to how to obtain your baby’s birth certificate to breast-feeding advice.

Narrative

A narrative blog is a powerful one, especially if you are the type of person who is a storyteller. When done correctly, a narrative blog pulls readers in and captivates them through a story that revolves about anything from a tense moment in the ER or a special encounter with a patient.

A narrative blog is an extremely powerful blog because you are using your personal experiences to drive the content. But be careful with a narrative format because it has the risks of running long and revealing protected patient information.

The blog One Case at a Time by anesthesia resident Felicity is one of the best narrative blogs I have read. She is a talented writer and has the ability to pull me into every one of her posts with dramatic and tense stories about her experiences with patients and colleagues.

Personal

A personal blog is one that might be educational and narrative, but pulls largely on personal opinions and stories to make a point. A personal blog is one that is powerful because it gives you insight into who the blogger is, and can be full of personal thoughts, fears and hopes.

If you are a health care provider who has the desire to give information through personal experiences, and if you are comfortable giving out details from your professional and person life, this type of blog can really help you connect with your audience.

I suggest following the blog Reflections of a Grady Doc, written by Dr. Kimberly Manning, if you are considering a blog that draws mostly from personal experiences. Her blog also combines a narrative element, which makes her blog even more engaging.

Although I encourage you to decide if you want your blog to be largely educational, narrative or personal, a good blog will incorporate all three. But by choosing a specific type of blog, you give yourself some boundaries and guidelines to follow, which can be extremely helpful when you are deciding what to write about on any given day. It also will attract a certain type of reader, so you’ll want to be aware of what you want your blog to accomplish.

If you are writing to a specific audience, educational might be your blog type. But if you are writing to a larger audience who may not be in your area, a narrative blog may fit you. And if you want to connect with your reader, wherever they may be, a personal blog is an effective way to accomplish that.

But no matter what type of blog you choose to write, keep in mind what your strengths are as a writer, because you’ll want to make sure you can sustain your blog and enjoy it at the same time.

“In Canada in health care we’re at a point where most hospitals accept the role of social media for branding and communication, but only the lead adopters are using it for patient engagement and for clinical use.” – Ann Fuller, public relations director, Children’s Hospital of Eastern Ontario (CHEO)

Call up the website home page for any large Canadian hospital and you’ll likely spot the familiar icons that link to the institution’s facebook, Twitter and YouTube accounts.

Hospitals are inherently conservative institutions and, as such, have been relative latecomers to adopt social media, which are broadly defined as digital channels that can facilitate timely, collaborative and interactive communication.

As they enter the social media fray, hospitals face a host of challenges and decisions. These range from basic upkeep—nothing is more frustrating to a potential user than a neglected or stale-dated facebook or Twitter account—to deciding how interactive to be with patients, and what staff should be trained and involved in social media use.

From marketing to improved care

Not all hospitals haven entered the fray—for example, smaller hospitals may not be able to afford the expertise and time involved in establishing a social media presence—and among those that have, how they use social media varies significantly.

Many still use the channels for marketing and old-style public relations communication—for example posting news releases—while some larger hospitals are more active, have thousands of followers, and can track and address patient concerns.

But the potential of using social media to improve patient care and patient experience is only beginning to be realized, according to health care digital communication leaders.

That’s not surprising because it’s only been a few years since hospitals began to take social media seriously; the Ontario Hospital Association hosted its fourth Social Media in Health Care conferencejust last month; the first was Jan 21, 2010.

Social media policies can allay concerns about risk

The issue of privacy and risk dominated discussions about social media several years ago, but that concern has begun to be addressed as hospitals formulate and adopt social media policies (seeCHEO policy, for example) that spell out ground rules for use.

An emerging debate contrasts the approach of hospitals that use a single channel “firehose” social media approach—institutions that have just one facebook and one Twitter account for all communication—and those that have multiple social media channels.

To Ed Bennett, who manages web operations at the University of Maryland Medical System, the progression from hosting single to multiple speciality channels—from addressing patient concerns at a broad level, to also addressing narrower concerns of specific patient groups—is a natural evolution.

Social media: this is where the public is talking about you

Part of his job is to monitor all online mentions of his medical centre and decide which ones are appropriate to respond to, and who should respond. “This is where conversations are moving, where they’re [the public] is talking about you, and if you don’t participate, you are cut off from the discussion.”

A lot of concerns are about services such as parking, or long waits in the ER, or how to get test results, he notes. “If you are able to resolve these, or just respond in a polite way, you can turn a negative into a positive.”

Craig Thompson, director of digital communications at Women’s College Hospital in Toronto, says the “low hanging fruit” that social media can address involves better communication about issues that frequently frustrate patients, such as hospital access and how to prepare for procedures. Beyond that, opportunities to use social media to improve patient experience “present themselves at different times, every organization has to find its own solutions.”

Social media such as facebook also present the opportunity to create “extensions of real life face-to-face patient support groups,” says Bennett. The Maryland University Medical System sponsors four or five of such groups, including for transplant and for trauma patients; participants have to be invited to join (the groups are closed) and the groups are moderated by a health care professional.

“Still, we explain that nothing on the Internet is 100% closed and warn people not to put out any information that wouldn’t be comfortable with the world seeing,” he says.

The multiple channel approach

Michelle Hamilton-Page is the manager of social media at CAMH (the Centre for Addiction and Mental Health in Toronto), which has a multiple channel model approach to social media (see, for example, its foundation-associated endstigma facebook page).

Hamilton-Page’s position is based in education, rather than communications, and she spends much of her time helping groups within CAMH think through whether social media can help them meet their objectives and, if so, how to go about it.

A similar approach is taken at St. Michael’s Hospital in Toronto, notes digital media manager Anthony Lucic. “People think of social media as mass communication, but it can be really focused and targeted. Sometimes, it’s about just wanting to talk with a core group of peers. Our approach is very grassroots, we sit down with people to find out who they want to engage, and what networks they could use.”

Children’s Hospitals have been early adopters of social media

Children’s Hospitals, like CHEO in Ottawa and the SickKids (the Hospital for Sick Children) in Toronto, are among the most advanced in terms of using social media. That’s partly because the patients, and their parents, are younger—and members of age cohorts that are relatively more comfortable using social media.

“Our patients, and their parents, have different expectations” compared to adult hospitals, says Ann Fuller, public relations director at CHEO. “New generations are used to sharing more and have different expectations of privacy than my mother did.”

And Fuller notes some doctors are saying it is time to relook at the idea that that physicians should not interact through social media with patients, point to “niche applications” where, for example, a clinician could be on facebook with a group of young patients with diabetes.

A recent research study at CHEO into patients’ use of facebook underscored its importance to teenagers with long-term and chronic illnesses and noted that only a few disclosed any personal health information on their facebook pages.

It concluded that that the need for social-network-based communication between patients and healthcare providers—now forbidden by some institutions—will increase and that “age-appropriate privacy-awareness education” should be strengthened.

Calls for more education, literacy

Better education about social media is something that Sivan Keren Young, manager of digital communications at Sunnybrook Health Sciences Centre, thinks is essential. “Everyone is using social media, but no one gets any social media literacy training, there’s nothing in schools, and that can cause mistakes, people can unintentionally do the wrong thing.”

Interestingly, it was disappointment about the level of public uptake for H1N1 vaccination was the inspiration for the first major Canadian examination of how health care institutions could use social media to understand and improve the patient experience.

What the investigators discovered was a whole series of anti-vaccination conversations about concerns about the vaccine—concerns that were inhibiting people from getting vaccination. “Public Health had no idea—none of that concern had turned up in their formal communication channels,” Fooks noted.

The advent of massively open online classes (MOOCs) is the single most important technological development of the millennium so far. I say this for two main reasons. First, for the enormously transformative impact MOOCs can have on literally billions of people in the world. Second, for the equally disruptive effect MOOCs will inevitably have on the global education industry.

While at Davos, I was fortunate to attend an amazing panel — my favorite of the conference — with a murderer’s row of speakers. Moderated by Thomas Friedman of The New York Times, the list of speakers: Larry Summers, former president of Harvard; Bill Gates; Peter Theil, a partner at Founder’s Fund; Rafael Reif, president of MIT; Sebastian Thrun, CEO of Udacity; Daphne Koller, CEO of Coursera, and a 12-year-old Pakistani girl who has taken a number of Stanford physics classes through Udacity. Below is a collection of some of the highlighted comments from this remarkable panel as well as a couple from audience members who were given an opportunity to comment.

Why this disruption is happening:

Peter Thiel, partner, Founders Fund
“In the United States, students don’t get their money’s worth. There’s a bubble in education as out of control as the housing bubble and the tech bubble in the 1990s. Education costs have gone up 400% since 1980. That’s the highest escalation of costs–higher than health care. There’s now a trillion dollars in student debt. And thanks to the way bankruptcy laws were restructured under George W Bush, you can’t get out of the college loan even if you become bankrupt. This is deeply broken.

“You have to ask yourself, ‘What is the nature of education as a good?’ Ideally you want it to be learning. But it also functions as insurance. Parents will pay a lot of money for insurance against cracks in our society. Education as insurance has something to be said because it connects to the economy. You know computer science, you can get a job. But education also functions as a tournament. You do well if you go to a top school but for everyone else the diploma is a dunce hat in disguise. People need to understand what they’re trying to do? Is it insurance? A tournament? Learning?”

Where we are in the evolution of this change:

Larry Summers, former President of Harvard
“It’s important to remember this really wise quote when thinking about the transition to online education: ‘Things take longer to happen than you think they will and then they happen faster than you think they could.’ If you had a discussion with dentists on tooth decay in 1947 it would have been about brushing your teeth and dental care, but the most important thing to happen with fighting tooth decay was fluoridated water and this is similar. It’s hard to know when it will happen but at some point this will be transformative. The first stage is when it does what was being done before but better. That’s what is happening now. But we’re going to where we don’t need to have two semesters, classes of same length, grading on the basis of things called exams. You can’t think of another industry where a list of top 10 providers is perfectly correlated to what it was in 1960.”

Daphne Koller, founder of Coursera
“We’re at 2.4 million students now. The biggest lesson I’ve learned on this is I underestimated the amount of impact this would have around the world. I really didn’t envision this scale and this impact this quickly.”

Raphael Reif, president of MIT
“We manage this transition very carefully. How can MIT charge $50,000 for tuition going forward? Can we justify that in the future? We see three components to MIT- first there’s the student life, then there’s the classroom instruction, but for us, the projects and labs activity is where real education occurs. But I don’t think we can charge that much for tuition in the future and it’s a big pressure point for us.”

Bill Gates, chairman of Microsoft
“When people first put courses online people thought they could charge money and no one bought them. They put them online but from a global perspective, all these high numbers of students we’re hearing about today, the effective number of people who use them is zero. It’s not widely used as a percentage of the global population. Our whole notion of ‘credential’, which means you went somewhere for a number of hours, needs to move to where you can prove you have the knowledge and the quality of these online courses need to improve. Over the next few years the quality will improve. 90% of these courses will be long forgotten and never viewed. Over the next five years this transformation will be phenomenal but only through a pretty brutal winnowing out process.”

On what an online education world means for hiring and talent for educators:

Rafael Reif
[On the question of how to hire professors in the MOOC era] “Can you hire MIT professors who know that they need to teach 150,000 people and not 150? We have spectacular researchers who are lousy teachers. That’s sad. A teacher in the future will become more like a mentor. The model of on campus education will be more about mentorship and guidance with research as an important factor.”

We can’t presume to know what format will work in the future:

Larry Summers
“It’s important to remember that we’re not so good at understanding the subtleties of environments that make them attractive to people. Look at football for example. One way to watch a game is to sit on a cold bench with no good food and bad bathrooms, the other is in your own living room, with replay, and food you like at your convenience. And then ask yourself- which would you guess people pay for? Which do people cheer for? You’d get it wrong. There are aspects of bringing people together in groups that we can’t quite understand and judge. The working out of this will depend a lot on formulas for making it attractive and collaborative. And as football example suggests, it won’t be immediately obvious what those models are.”

What’s next in this space?

Bill Gates
“Who is going to jump first into granting a degree that doesn’t have the seat time requirement that we do today that employers will see as credible? Where does the credibility come from?

Sebastian Thrun, CEO of uDacity
“I think the question is how do you make the credential have currency that an employer knows? We’ve had good success. We have 350 companies who have hired our students. Employers worry about soft skills and we can measure that and it’s on equal performance with hard skills. The credential thing is interesting- we launched a class for credit with California schools for remedial math. We priced them at 10-15 percent of what college costs. There are lots of improvements to be made, but the outcome tends to be better today with us.”

Jimmy Wales, founder, Wikipedia
“The overall quantity and quality of formal education hasn’t changed whereas the informal education has skyrocketed in the last 30 years. People used to go to library and now go to Wikipedia. We haven’t really begun to understand the impact on that.”

Muhammad Yunus, Nobel Peace Prize Winner, Founder Grameen Bank
“What does this all mean? The technology gives us tremendous power to solve this stark problem all around us. We need to design these so no child is left out of this. What need to ask, what is education after all? We need to resolve that. What are we getting our young people ready for? It’s for the purpose of our life. And we need to make sure we give people a purpose to their life. It won’t be done by current system. It will be done by people who have nothing to do with current system.”

Social media includes all online tools and technologies which let people communicate and publish content easily. The most popular among them are Blogs, Facebook, Twitter and YouTube. Widely used for communications and marketing, these channels are considered as important (if not more important) as mainstream media channels like newspapers and television.

The use of social media in healthcare represents an increasingly effective tool in healthcare. It can be used to communicate with consumers, inform about new wellness schemes, market healthcare products, provide basic healthcare advice, inform about latest medical devices, get instant public feedback and much more. At the same time,Healthcare social mediaalso presents challenges, including risks to information accuracy, organizational reputation, and individual privacy.

The primary focus for most organizations’ social media programs is marketing and communications. Hospitals are using social media to target health consumers. As consumers are shifting to online searches before making important healthcare decisions, hospitals are looking at creating solid social media presence and fostering long term relationships with their consumers. Internationally, Mayo Clinic has taken the lead in healthcare social media. Mayo Clinic’s Center for Social Media has a stated mission to “lead the social media revolution in healthcare, contributing to health and well being for people everywhere.” Indian hospitals are not far behind. The Apollo Hospitals twitter account has more than 2000 followers. Their Facebook page makes wonderful use of the timeline feature, has 91,000 likes and is fast growing. Their YouTube channel has been active for the past 4 years.

Many organizations have also formed online support groups for patients. Patients are encouraged to share their personal experiences and this consumer generated content is an invaluable source of information for other patients. Many doctors, too, have joined such support forums and provide information on various disorders. In a country like India where 70% of healthcare services are paid for ‘out-of-pocket’, Social Media becomes all the more important for healthcare marketing. Companies selling healthcare devices have found social media influences purchasing decisions. Internationally, many pharma companies too have realized the enormous potential of social media. Almost all major drug companies now have social media presence. Companies like Pfizer, Novartis, J & J and Sanofi-Aventis have launched many innovative social media campaigns. The HR departments in many healthcare organizations are using social media sites to spot and recruit talent.

These new tools of communications come with their own risks and dangers. Like a double edged sword, all points in favor of social media usage also contribute to the dangers associated with their use. The dangers social media exposes healthcare to are internal as well as external. Flippant remarks made by nurses or doctors online can be misconstrued by general public. Cases abound where protected health information was shared online inadvertently. The danger of violations of patient privacy cannot be overstated.

Conversations cannot be controlled and negative remarks made on social media by disgruntled employees or consumers cannot be erased. Such risks can be minimized by fostering positive comments by consumers and show casing achievements and consumer centeredness via these communication channels.

Organizations need to gear up to grab the opportunity and face the challenge that is social media. They need to monitor their ‘social presence’ and keep track of consumer sentiments. Use of social media for innovative marketing and communication campaigns should be encouraged. Organizations should educate both their employees and the public on their privacy practices to encourage responsible use of their social media sites. Guidelines and specific social media policies need to be in place to promote risk free use of social media by employees. Once policy is established, employees, volunteers, contracted employees, and medical staff members should receive training and education to ensure they are aware of the policies and procedures. With proper policy and training for employees, healthcare is slowly but surely taming the social media beast that technology has helped unleash on the markets.

Harnessing the cloud of patient experience: using social media to detect poor quality healthcare

Recent years have seen increasing interest in patient-centred care and calls to focus on improving the patient experience. At the same time, a growing number of patients are using the internet to describe their experiences of healthcare. We believe the increasing availability of patients’ accounts of their care on blogs, social networks, Twitter and hospital review sites presents an intriguing opportunity to advance the patient-centred care agenda and provide novel quality of care data. We describe this concept as a ‘cloud of patient experience’. In this commentary, we outline the ways in which the collection and aggregation of patients’ descriptions of their experiences on the internet could be used to detect poor clinical care. Over time, such an approach could also identify excellence and allow it to be built on. We suggest using the techniques of natural language processing and sentiment analysis to transform unstructured descriptions of patient experience on the internet into usable measures of healthcare performance. We consider the various sources of information that could be used, the limitations of the approach and discuss whether these new techniques could detect poor performance before conventional measures of healthcare quality.

If you’re a health care professional, chances are you know a bit about social media, possibly feel compelled to use it sometimes and you might actually be participating in the Facebook/Twitter/LinkedIn/blog revolution.

But there can be real problems in using social media in the health care context. Whether you are in private practice or work for a group of large hospital network, social media mistakes can be costly in terms of misrepresenting your specialty, breaching patient confidentiality, or limiting your business growth. Do you make the following mistakes when using social media?

1. Avoidance. Most health care professionals wish social media didn’t exist. They see it as confusing and a distraction. The questions about how, when and why social media is important and useful give them indigestion and some go to great lengths to tell others to” just say no” to all thing social media. The problem with this is social media exists for millions of people (500 million on Facebook alone) and to ignore all things social media is to ignore your patients’ needs and a wide-range of new business development opportunities.

If you’re reading this, you probably aren’t a total avoider, but reading and engaging are two very different things. Social media is here to stay. Your clients and patients probably use it more than you can even imagine. If you hear colleagues “pooh-pooh”ing social media, correct them quickly. It’s here, it’s real, it’s a force to be reckoned with and made your own.

2. Fear. After avoidance, many health care professionals move to the stage of reluctant acceptance, but aren’t happy about it. They are ignorant of why social media is important or how to effectively leverage it to help their patients and grow their practice.Ignorance plus anxiety = fear and we’ve got a lot of fear in health care about social media. But the fear seems silly from some of the most educated and intelligent people on the planet. I mean, we are not born to do heart or brain surgery (and I sure as hell fear the idea of me doing any kind of surgery), support someone through a suicidal crisis or diagnose schizophrenia. We had to learn how to do these things over time. So too social media. The sky is not falling. You can learn how to do social media well and effectively. Learning is kinda your thing.

It does take courage to try something new and work at it until we see a positive return. Will you be a courageous health care provider and learn, experiment and grow via social media?

3. Sloth. Doing social media well is work. Not save-a-life work or Alaskan salmon fishing work, but it requires time, thought and energy. I hear many health care professionals bemoan the fact that “social media is hard work,” and then vent on and on about the unfairness of health care reform, patients not valuing them, the jerks over at health care insurance companies 1,2 and 3.

It’s important to remember that we all have the same number of hours in a day. Someone who spends an hour writing and talking about negative stuff has wasted 60 minutes of their life. Another person who uses that time to connect with people is doing a service and building their future. Use your time wisely, work to achieve positive goals. How are you currently using your time?

4. Narcissism. Many health care professionals see Twitter as the place where people talk about their life and what they had for lunch. One of my colleagues has this as his email signature: “Follow me on Twitter: I’ll tell you how I feel.” Ugh. Narcissistic. Why? First, he doesn’t get it, second, instead of trying to learn more and understand, he mocks it and looks foolish. (As an aside if you don’t understand a technology, it is best to say nothing, rather than look stupid in front of colleagues who do understand … just saying.)

Despite how it may seem, social media is not about you. No one reading your wall or tweets really cares about how you feel. Social media is about making connections, helping others with useful information, sharing ideas and building business opportunities. If you’re not into doing the above things, by all means avoid social media. But if you want to touch lives and grow professionally, social media is a neat way to jump start the process.

5. Selfishness. Social media is about giving. Giving great content, information, tips that people can use to live a better, healthier life. Sharing articles and info from other sources that you know will help your readers. The more you give, the more people follow you and when you make an offer to sell a service or product, your followers are so impressed with your quality as a person and a professional, they can’t wait to pay to get more support and help from you.

Social media is not advertising, nor is it your personal water cooler. Selfish use of social media includes only broadcasting your articles and blog posts, using Twitter as an advertisement stream rather than an opportunity for connection. If you stream only includes your posts about your business and you, take note. The most powerful use of Twitter is when you use the retweet (RT) and the @ reply. The people who are leveraging Twitter to the max say that they retweet and reply 90% of the time, with only 10% of their tweets about their own stuff. Share, converse, introduce people to one another .. you’ll get so much more out of the social media experience. How do you give on social media?

6. Unethical shenanigans. Social media can be used unethically. The problem is,most health care professionals don’t realize when they are being unethical online. So let’s try to make this simple. It is unethical to breach your clients’ confidentiality online. Do not, under any circumstances mention your clients’ experiences or demographics in your social media space.

Another unethical move is to tell your clients how to use social media vis-a-vis your professional relationship. Why? By doing this you are misusing your position of power in the treatment dynamic.

Let’s talk about this for a bit.

Some mental health professionals want to develop social media policies and often these policies say things like, “I have a Twitter account, but if I find you’re following me I’ll remove you,” or “I’m on Facebook, but you can’t friend me because it could be a breach of confidentiality.”

At first glance these statements seem ok, until you think about what the professional is saying here. Essentially she’s saying “I have a social media life and you can’t participate. I will tell you how to engage in social media.” The problem is, social media is free and open access. When you have an open Twitter account you imply that anyone who wants to can follow you. Otherwise, you can make the account private. So while you can prevent your clients from calling you at home or knowing where you live, you really can’t tell them what to do in social media if you have public accounts. Well, you can try to tell them what to do but how does that impact your relationship and how do you enforce it?

The attraction of social media is it puts all of us on an equal playing field. There is no cost to entry. If I want to follow Lance Armstrong, President Obama, or musician John Mayer, I can. When we try to tell our clients what to do in the social media space we are abusing our power. If you’re not comfortable with the openness of this, privatize your accounts or simply don’t participate.

One more unethical trap: Googling clients. Awhile ago this was a topic of discussion in mental health circles. Some argued that, in cases of emergency, it’s acceptable to Google a client to get more information. I disagree. It’s a violation of privacy and opens you up to a pandora’s box of legal liabilities.

7. Lack of imagination. This may be the worse sin of all. I’ve realized over the last few months just how powerful social media can be to influence people’s ideas, change behavior and educate large groups of people. We in health care get so stuck on the first 6 sins in this list that we don’t consider all of the positive possibilities. We stop at simplistic uses, put up barriers by citing HIPAA, wait for someone more official than we are to give us permission, and essentially stop growth for ourselves and our clients. It’s frustrating.

What if we saw social media as a problem solver? What if we devised ways to use it to educate, inform, treat and improve lives? What if we become open to the possibilities and then grapple with the confidentiality and access issues? In health care we tend to put the cart before the horse. We think, “How can this all go wrong?” before we imagine how the world will look if it all goes right.

We can send humans into space for months at a time, do all our banking securely online and video chat with people on the other side of the world. I think we can find a way to make the technology of social media work for health care. Don’t you?

I’ve always believed that we learn best through stories, so not only have I included notable events from my personal social media journey, but also dozens of case studies and anecdotes from social media leaders that I’ve had the pleasure of connecting with over the years, including Vineet Arora, MD, Katherine Chretien, MD, Natasha Burgert, MD, Dave deBronkart, Susannah Fox, Kerri Morrone Sparling, Wendy Sue Swanson, MD, and Bryan Vartabedian, MD.

Their perspectives provide a window into how patients are using online tools to find their physicians and how an online reputation can be managed by busy, practicing doctors.

I invite you to explore this definitive guide for doctors and medical practices on how to use social media and establish, manage, and protect an online reputation.

“For the physician contemplating the use of social media, this lovely volume is a precious and invaluable guide.”Abraham Verghese, MD, author of Cutting for Stone

“As the digital era inevitably invades the medical cocoon, there is a vital unmet need for physicians to adapt, especially to new challenges such as dealing with one’s online reputation. Kevin Pho, a leader in the convergence of social media and healthcare, with Susan Gay, provide a comprehensive and extremely useful roadmap for doctors. Instead of default, sitting duck status, this information and perspective enables physicians to take charge.”Eric Topol, MD, author of The Creative Destruction of Medicine

“An insightful and thought provoking examination of the changing landscape of medicine, filled with practical advice for clinicians.”Jerome Groopman, MD and Pamela Hartzband, MD, authors of Your Medical Mind: How to Choose What Is Right for You

“As one of the most prolific practitioners in the world of social media, Kevin Pho’s insights for doctors and other health professionals are soundly based on experience. His ability to demystify this arena for others comes from a clear and concise exposition of what is fact and what is fear.”Paul F. Levy, Former CEO, Beth Israel Deaconess Medical Center